What are the options for implant size?

The ultimate size of the breast is mainly a personal decision by the patient. Cup size is an inexact estimate of the final size since cup sizes vary with the bra manufacturer and how tight or loose the patient wears her bra as well as how much breast tissue is already present. Describing the preferred cup size does aid the surgeon, but it also helps to look at pictures or photos to show the physician the desired final look.

The most accurate method of estimating the implant size (in ounces) is to fill a plastic bag with measured amounts of water and place in a bra with the patient's estimated cup size. One can see with the bra on and covered by a sweater what the final result will approximate.

Patients most often comment that, "I wish I had gone larger," although there is a rare patient who feels she is too large.

What are risks and complications of breast augmentation?

1. Infection

Although infection is rare, it can be a very distressing problem. Signs of infection are fever, redness, swelling, and discomfort. If the infection does not respond rapidly to antibiotic treatment, the implant must be removed and the implant can be replaced three (3) months after the wound is completely healed.

2. Bleeding

If bleeding occurs into the implant pocket after surgery, the implant must be surgically removed, the bleeding controlled, the wound washed out, and the implant replaced. Signs of bleeding include marked swelling, increasing pain, and bruising.

3. Capsule contracture

Hardening of the breast with distortion and sometime pain may require surgical incision of the fibrous scar capsule around the implant (capsulotomy) or partial or total removal of the scar capsule (capsulectomy). The implant can be immediately placed back in the new packet. About 30-35% of patients have recurrent capsule contracture.

Other means of treating the contracture is replacement of a smooth implant with a textured one or placing the implant in a new pocket either under the breast or under the muscle.

If capsule contracture occurs multiple times, the patient may decide to remove the implants permanently.

4. Asymmetry

Sometimes the implant will slip out of the position in which it was initially placed and appear too high, too low, or to one side. Most of the time, this requires surgical repair.

5. Problems with Mammography

The implant will block some areas of the breast from being visualized on mammography. This is usually less if the implant is placed under the muscle.

Because breast implants might affect the clarity of the mammogram, patients who have multiple close family members with breast cancer probably should not have breast implants.

6. Autoimmune Disease

With all the confusion in the newspaper, magazines and on the T.V. or radio, there has been a fear that silicone implants may cause autoimmune disease. At this time there is no scientific evidence that silicone causes autoimmune disease.

7. Cancer

According to the FDA, breast implants can cause anaplastic large cell
lymphoma, in rare cases.

8. Calcifications

Implants that have been in a patient for many years may cause calcifications in the scar capsule around the implant. These calcifications can almost always be distinguished from the calcifications which may indicate breast cancer.

9. Deflation

An implant may leak from weakness in the patch or valve area, a hole from incomplete inflation, or other factors. The more modern saline implants have been estimated to leak in 1-5% of cases.